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Los virus se sitúan en un lugar preferente entre los agentes causales de diarrea aguda, en particular en la infancia. En este contexto el papel de los astrovirus, coronavirus, torovirus y picobirnavirus es emergente. Los astrovirus se han detectado en las heces entre el 1,2 y el 20 % de niños con diarrea que requieren atención médica en una gran variedad de localizaciones geográficas. Se han descrito brotes epidémicos en escuelas, guarderías y salas pediátricas, y son más frecuentes entre niños de menos de 3 años. En climas templados se ha demostrado una mayor incidencia invernal, y en climas tropicales ésta es similar en todo el año, siendo su transmisión preferente por vía orofecal. Se han reconocido siete serotipos de astrovirus humanos, de los cuales el más común es el uno. Los viriones pueden eliminarse durante amplios períodos y detectarse mediante microscopia electrónica. En estudios epidemiológicos se emplean técnicas de enzimoinmunoanálisis para detectar el antígeno común de grupo y se han desarrollado también técnicas basadas en la detección de ácidos nucleicos mediante hibridación y amplificación (reacción en cadena de la polimerasa).
Los coronavirus entéricos se han asociado con frecuencia con enfermedad gastrointestinal en recién nacidos y niños menores de 12 años. El papel de los torovirus y picobirnavirus como causa de gastroenteritis es también emergente. Se necesitan estudios epidemiológicos para determinar su verdadera frecuencia en la comunidad, identificar sus mecanismos de transmisión y explicar la fisiopatología de los cuadros provocados por estos agentes.
Palabras clave:
Gastroenteritis
Astrovirus
Coronavirus
Torovirus
Picobirnavirus
Viral agents are one of the main causes of acute diarrhea, particularly in infants and young children. Astrovirus, coronavirus, torovirus, and picobirnavirus are increasingly being identified as causative agents of gastroenteritis. Astroviruses have been detected in the stools of between 1.2 % and 20 % of children with diarrhea requiring medical care in a variety of geographical areas. Outbreaks have been described in schools, day care settings and pediatric wards. Children younger than 3 years old are the most frequently affected. In temperate climates incidence is greater in winter whereas in tropical areas infection occurs throughout the year. Transmission is mainly through the fecal-oral route. At least seven serotypes of human astroviruses have been recognized and serotype 1 is more common than the other serotypes. Astroviruses are often shed in stools during long periods and can be detected by electron microscopy. An enzyme-immunoassay technique that detects the astrovirus group antigen has been widely used in epidemiological studies. Nucleic acid hybridization and polymerase chain reaction-based techniques have also been used. Enteric coronaviruses have most frequently been associated with gastrointestinal disease in neonates and children younger than 12 years old. The role of toroviruses and picobirnaviruses as causative agents of gastroenteritis is still emerging.
Further epidemiological studies to determine the frequency of these viruses in the community and to identify their mechanisms of transmission are needed, as are further studies to elucidate the pathophysiology of diseases due to these agents.
Key words:
Gastroenteritis
Astrovirus
Coronavirus
Torovirus
Picobirnavirus
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